Computer-implemented medical method for radiation treatment (RT) planning for treating multiple lesions of a patient

1 . A computer-implemented method for radiation treatment (RT) for treating multiple lesions of a patient, the method comprising:

determining for at least one or more lesions of the patient, one or more conformal apertures to be used during radiation treatment;

performing a treatment optimization based on conformal shapes for one or more lesions of the patient using a dynamic conformal arc (DCA) optimizer thereby calculating a first irradiation treatment;

using the calculated first irradiation treatment as initialisation of a volumetric intensity modulated arc therapy (VMAT) optimizer;

performing an optimization for the one or more lesions of the patient using the initialized VMAT optimizer; and

wherein the VMAT optimizer keeps all determined conformal apertures conformal during the optimization.

2 . The method according to claim 1 :

wherein the determining step is carried out for at least one irradiation angle facilitated by a radiation treatment (RT) apparatus; and

wherein an irradiation angle is defined by a combination of a patient table angle and a gantry angle.

3 . The method according to claim 1 :

wherein the determining step is dependent from at least one of

a shape of the respective lesion of the one or more lesions of the patient;

an organ at risk (OAR) of the patient;

a previous result of this determining step for another irradiation angle, wherein an irradiation angle is defined by a combination of a patient table angle and a gantry angle; and

one or more mechanical constraints or of an irradiation source of a radiation treatment (RT) apparatus:

proximity of other lesions from the repsective lesion;

size of the respective lesion; and

location of the respective lesion in a body of the patient.

4 . The method according to claim 1 , further including:

providing the VMAT optimizer with a dose prescription for said patient; and

wherein the dose prescription defines prescribed dose values to be delivered to one or more of the lesions of the patient, and/or one or more dose limits for organs at risk/risk structures of the patient.

5 . The method according to claim 1 :

wherein the determining step is carried out by receiving a user input about the at least one or more lesions of the patient, and about information whether the at least one or more lesion is to be irradiated with conformal apertures or with modulated apertures.

6 . The method according to claim 1 :

wherein the determining step is carried by a computer-implemented method of automatically determining for the at least one or more lesions of the patient one or more conformal apertures to be used during radiation treatment; and

wherein said automatic determination is based on data analysis of customer data, and/or is based on a simulation.

7 . The method according to claim 1 :

wherein the determining step is carried out before the optimization for the one or more lesions of the patient using the VMAT optimizer or

wherein the determining step is carried out during the optimization for the one or more lesions of the patient using the VMAT optimizer.

8 . The method according to claim 1 :

wherein during the optimization step using the VMAT optimizer a second irradiation treatment is calculated.

9 . The method according to claim 8 ,

wherein the calculated second irradiation treatment uses at least one hybrid arc containing both conformal apertures of a Multi Leaf Collimator (MLC) of a radiation treatment (RT) apparatus and modulated apertures of the MLC of the RT apparatus.

10 . The method according to claim 1 :

wherein during the optimization step using the VMAT optimizer a respective dose distribution for the one or more lesions of the patient is optimized at the same time.

11 . The method according to claim 1

wherein at each iteration of the optimization step using the VMAT optimizer the respective dose for the one or more lesion of the patient is known.

12 . The method according to claim 1

wherein the initialisation of the VMAT optimizer contains a provision of initialized apertures based on a calculated first irradiation treatment; the method further comprising the step:

using, by the VMAT optimizer and during the optimization, the initialized apertures for further optimizing at least one of conformity, iso-dose line prescription of the one or more lesions at the same time, normal tissue dose and dose to risk structures, gradient index, treatment time, and modulation complexity.

13 . The method according to claim 1 , the method further comprising;

performing an arc setup optimization.

14 . The method according to claim 13 , wherein the arc setup optimization comprises:

acquiring a first arc setup comprising a plurality of arcs, each arc being defined by a combination of a patient table angle, a gantry start angle and a gantry stop angle;

distributing a plurality of target volumes, which describe the one or more lesions of the patient, to the arcs of the first arc setup thereby providing a packed first arc setup;

comparing said packed first arc setup with one or more predefined arc setup constraints;

wherein the one or more predefined arc setup constraints are selected from: a number of patient table angles per target volume, a number of passes, a sum of gantry span per metastasis over all arcs, a minimum table span, and a total number of patient table angles;

and the method further comprising:

automatically suggesting at least a second arc setup based on a result of the comparison; and

using the suggested second arc setup during performing the treatment optimization based on conformal shapes using the DCA optimizer.

15 . The method according to claim 14 ,

wherein for each of the one or more predefined arc setup constraints a minimum and a maximum is defined.

16 . The method according to claim 14 ,

wherein a predefined arc setup constraint about the number of patient table angles defines a minimum number of patient table angles; and

wherein, if a result of the comparison of the packed first arc setup with the one or more predefined arc setup constraints is that the minimum of the number of patient table angles is not violated, the method further comprises the step:

removing a patient table angle from the first arc setup; and/or

wherein the predefined arc setup constraint about the number of passes defines a minimum number of passes; and

wherein, if the result of the comparison of the packed first arc setup with the one or more predefined arc setup constraints is that the minimum of the number of passes is not violated, the method further comprises the step:

removing a pass from the first arc setup.

17 . A non-transitory computer readable storage medium comprising instructions which, when executed by at least one processor, cause the at least one processor to:

determine for at least one or more lesion of a patient, one or more conformal apertures to be used during radiation treatment;

perform a treatment optimization based on conformal shapes for the one or more lesions of the patient using a dynamic conformal arc (DCA) optimizer thereby calculating a first irradiation treatment;

use the calculated first irradiation treatment as initialisation of a volumetric intensity modulated arc therapy (VMAT) optimizer;

perform an optimization for the one or more lesions of the patient using the initialized VMAT optimizer; and

wherein the VMAT optimizer keeps all determined conformal apertures conformal during the optimization.

18 . A medical system, comprising:

at least one processor;

at least one electronic data storage device storing at least patient data describing multiple lesions of a patient; and

a medical device for carrying out a medical procedure on the patient, wherein the at least one processor is operably coupled to:

the at least one electronic data storage device for acquiring, from the at least one electronic data storage device, the patient data describing the multiple lesions of the patient, the at least one processor operable to:

perform an optimization for the multiple lesions of the patient using an initialized volumetric intensity modulated arc therapy (VMAT) optimizer; and

wherein the VMAT optimizer keeps all determined conformal apertures conformal during the optimization; and

issuing a control signal to the medical device for controlling an operation of the medical device on a basis of a result of the optimization.

19 . The medical system according to claim 18 , wherein the medical device comprises:

a radiation treatment (RT) apparatus comprising a treatment beam source and a patient support unit;

wherein the at least one processor is operably coupled to a radiation treatment apparatus for issuing a control signal to the radiation treatment apparatus for controlling, on the basis of a result of the optimization, at least one of:

the operation of the treatment beam source, or

the position of the patient support unit.